Inquiry: The Journal of Health Care Organization, Provision, and Financing (Mar 2023)

Perspectives of Frequent Users of Emergency Departments on a Case Management Intervention: A Qualitative Study

  • Luana Schaad MS,
  • Madison Graells MS,
  • Miriam Kasztura MS,
  • Elodie Schmutz MS,
  • Joanna Moullin PhD,
  • Olivier Hugli,
  • Jean-Bernard Daeppen,
  • Julia Ambrosetti MS,
  • Julien Ombelli MS,
  • Michel Golay MS,
  • Vincent Ribordy,
  • Véronique S. Grazioli PhD Privat-Docent,
  • Patrick Bodenmann

DOI
https://doi.org/10.1177/00469580231159745
Journal volume & issue
Vol. 60

Abstract

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Background: Effective management of frequent users of emergency departments (FUED) remains challenging. Case management (CM) has shown to improve patient quality of life while reducing ED visits and associated costs. However, little data is available on FUED’s perception of CM outside of North America to further improve CM implementation. Objectives: Explore the FUED’s perspectives about CM in Switzerland. Design, Setting & Participants: Semi-structured qualitative interviews eliciting FUED’s experiences of CM were conducted among 20 participants (75% female; mean age = 40.6, SD = 12.8) across 6 hospital ED. Outcomes measures & Analysis: Inductive content analysis. Main Results: Most participants were satisfied with the CM program. In particular, FUEDs identified the working relationship with the case manager (cm) as key for positive outcomes, and also valued the holistic evaluation of their needs and resources. Overall, patients reported increased motivation and health literacy, as well as facilitated interactions within the healthcare system. Conversely, a small number of participants reported negative views on CM ( ie , stigmatization, lack of concrete outcomes). Barriers identified were cm’s lack of time, COVID-19′s negative impact on CM organization, as well as lack of clarity on the objectives of CM. FUED perceived CM as useful, in particular establishing a working relationship with the cm. Our results suggest that CM can be further improved by (1) professionals remaining non-judgmental toward FUED, (2) making sure the aims and objectives of the CM are understood by the participants, and (3) allowing more time for the cm to carry out their work.